A Quantitative Analysis of Transfemoral Prosthetic Alignment

描述(由申请人提供)： 项目概述/摘要假肢对齐是下肢截肢者成功康复的一个重要方面，也是假肢能否恢复功能、最大限度地减少步态偏差以及使用者是否感到舒适的决定性因素。假肢医生经过培训，根据临床经验和患者反馈，在调整假肢时遵循迭代程序。假肢医生不断地调整假体对齐，直到他们满意患者的步态偏差很少，并且感到舒适。然而，这一过程的重复性很差，几乎没有科学依据。研究人员和临床医生首先必须更好地了解假体对齐的变化与截肢者的生物力学反应之间的关系，以改进经股动脉对齐的过程，为实践提供客观的依据。肢体矢状面不稳是经股截肢患者的主要问题，因为他们无法直接控制假体膝关节。因此，经股截肢者依靠髋部的肌肉策略来控制膝关节的屈曲和伸展。假体错位的一个实际后果是，它可能需要截肢者产生过多的髋关节力矩来控制他们的膝关节，导致新陈代谢能量消耗增加和行走时的疲劳。不适当的对齐也可能导致步态不对称、假体部件性能不佳，以及插座和残肢之间不受欢迎的压力，导致不适和压疮。本研究的目的是评估单侧经股截肢患者的步态生物力学如何随着矢状面排列的系统性改变而改变。在笔直的水平行走过程中，将研究假肢膝关节的直线平移和假肢脚的旋转。为了测量股骨截肢者对矢状面排列变化的反应，我们将使用定量步态分析来收集运动学和运动学数据。我们还将获得髋部肌肉系统的肌电数据、眶内接触压力和能量消耗测量。这项拟议的工作将描述假体错位与经股截肢者步态功能反应之间的关系，包括生物力学不对称、能量消耗增加和残肢疼痛。这项研究的结果将提供一个透彻的了解如何经股截肢者控制他们的假体膝关节，并可能建立一个更系统的方法，以临床假体对齐过程。 公共卫生相关性： 项目简介这项工作直接适用于退伍军人管理局的患者护理任务，因为结果可能会改善腿部截肢者的步态和生活质量。由于插座安装、假体对齐和假体性能的缺陷，经股截肢者的步态不如健全者。这项拟议的工作将描述假体错位和经股截肢者步态适应性之间的关系，包括步态不对称、运动效率低下、能量消耗增加和残肢疼痛。随着更好地了解假体对齐如何影响经股截肢者的行走能力，这项研究将建立更好地量化与对齐相关的结果的标准。此外，彻底了解经股截肢者如何控制他们的假体膝关节可能对康复治疗有影响，并为改进假体膝关节设计提供洞察力。

DESCRIPTION (provided by applicant): Project Summary/Abstract Prosthetic alignment is an important aspect in the successful rehabilitation of lower-limb amputees and is a deciding factor in whether the prosthetic limb will restore function, minimize gait deviations, and be comfortable for the user. Prosthetists are trained to follow an iterative procedure when aligning a prosthetic limb that relies on clinical experience and patient feedback. The prosthetist continually modifies prosthetic alignment until they are satisfied that the patient exhibits few gait deviations and is comfortable. However, this process suffers from poor repeatability and little scientific justification. In order to improve the process of transfemoral alignment and promote an objective basis for practice, researchers and clinicians must first acquire a better understanding of the relationship between variations in prosthetic alignment and the biomechanical response of the amputee. Sagittal instability of the limb is a primary concern for transfemoral amputees because they do not have direct control of their prosthetic knee joint. As a result, transfemoral amputees rely on muscle strategies at the hip to control knee flexion and extension. A practical consequence of prosthetic misalignment is that it may require the amputee to generate excessive hip moments to control their knee joint, resulting in increased metabolic energy expenditure and fatigue during walking. Improper alignment may also contribute to gait asymmetries, poor performance of prosthetic components, and undesirable pressure between the socket and residual limb, giving rise to discomfort and pressure sores. The purpose of this study is to evaluate how gait biomechanics of persons with unilateral, transfemoral amputations are altered in response to systematic changes in sagittal- plane alignment. Both linear translations of the prosthetic knee and rotations of the prosthetic foot will be investigated during straight, level walking. To measure the response of transfemoral amputees to variations in sagittal-plane alignment, we will collect kinematic and kinetic data using quantitative gait analysis. We will also acquire EMG data of hip musculature, intrasocket contact pressure, and energy expenditure measurements. This proposed work will characterize the relationship between prosthetic misalignment and the functional response of transfemoral amputee gait, including biomechanical asymmetries, increased energy expenditure, and residual limb pain. The results of this study will provide a thorough understanding of how transfemoral amputees control their prosthetic knee joint and may establish a more systematic approach to the process of clinical prosthetic alignment. PUBLIC HEALTH RELEVANCE: Project Narrative This work is directly applicable to the VA's Patient Care Mission because the results may improve the gait and quality of life of persons with lower-extremity amputations. The gait of persons with transfemoral amputations is inferior to that of able-bodied individuals due to deficiencies in socket fit, prosthetic alignment, and performance of components. This proposed work will characterize the relationship between prosthetic misalignment and adaptations in transfemoral amputee gait, including gait asymmetries, kinetic inefficiencies, increased energy expenditure, and residual limb pain. With a better understanding of how prosthetic alignment affects the walking performance of transfemoral amputees, this study will establish criteria to better quantify outcomes related to alignment. Furthermore, a thorough understanding of how transfemoral amputees control their prosthetic knee may have implications for rehabilitation therapies and provide insight for improved prosthetic knee designs.